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[Illustration: ETTIE A. ROUT. [_Vandyk, London._]]
SAFE MARRIAGE
A RETURN TO SANITY
BY
ETTIE A. ROUT
WITH PREFACE BY
SIR WILLIAM ARBUTHNOT LANE, BART., C.B., M.S.,
(Consulting Surgeon to Guy's Hospital), etc.
LONDON:
WILLIAM HEINEMANN
(Medical Books) Ltd.
1922
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| |
| _PREVENTION OF VENEREAL DISEASE_ |
| |
| By SIR ARCHDALL REID, K.B.E., M.B. |
| |
| With an Introduction by SIR BRYAN DONKIN, M.D. |
| |
| _Crown 8vo. 447 pages. 15s. net. Weight 2 lbs. Inland |
| postage, 9d._ |
| |
| This book is addressed on the one hand to those who would |
| prevent venereal disease in themselves, and on the other, to |
| those who would prevent it in the community. |
| |
| _Lancet._--"A powerfully written and valuable volume." |
| |
| _The Medical Press._--"We _positively assert_ that it is the |
| duty of every medical man to _master_ its contents." |
| |
| LONDON: WM. HEINEMANN (Medical Books) Ltd. |
| |
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The French Government has bestowed the premier decoration for
women, The Reconnaissance Française, upon Miss Ettie Rout, of the
New Zealand Volunteer Sisters, "for work done during the war (as
head of Anzac Soldiers' Club in Paris), and in 1919-1920 as head of
American Red Cross Depôt and Canteen at Villers-Bretonneux, where
she helped a great many French soldiers, and rendered precious
service to the civilian population of the commune." The War Office
also conveyed thanks to Miss Rout "for gallant and distinguished
services in the field." "I have it in command from the King," wrote
the Secretary of State for War, on 1st March, 1919, "to record His
Majesty's high appreciation of the services rendered."
PREFACE.
It affords me great pleasure to write a short preface to this book, since
it deals with a matter in which I (in common with all those who are
intensely interested in the health of our race) am glad to take an active
part.
To no woman has it been permitted to do the same amount of good, and to
save more misery and suffering, both during and after the war, than to
Miss Ettie Rout. Her superhuman energy and indomitable perseverance
enabled her to perform, in the most efficient manner possible, a work
which few women would care to handle, and of which but an infinitesimally
small number are capable. The French Government fully recognised the great
services she rendered to the Allies, and did her honour. The book she has
written is one of very great value, in that its object is the Health,
Happiness, Morality and Well-being of the Community.
Not only has Miss Ettie Rout the qualities that characterise all great
humanitarians, but she also possesses, in a unique degree, an intimate
knowledge of the terrible troubles that arise from irregular intercourse,
and of the manner in which they can be reduced and perhaps eliminated.
In this book she deals with such simple hygienic measures as are little
known in England, though they are in common use in France and in the
United States, in both of which countries sound practical common sense
prevails.
She is persuaded that marriage is the goal to be reached by all, and that
everything possible should be done to facilitate it, and so to diminish
vice. In her efforts to bring about this happy issue she has the good
wishes and congratulations of all who have the health of the community at
heart.
W. ARBUTHNOT LANE. 21, Cavendish Square, London, W.1.
_March 25th, 1922._
CONTENTS.
PAGE
FOREWORD xiii
I. INTRODUCTION 17
II. PRACTICAL METHODS OF PREVENTION
A. FOR WOMEN 32
B. FOR MEN 51
III. MEDICAL FORMULÆ 59
IV. COMPULSORY TREATMENT 63
V. CONCLUSION 65
APPENDIX I 69
APPENDIX II 73
NOTE AND ADVERTISEMENT 75
"Knowledge comes, but Wisdom lingers, and I linger on the shore,
And the Individual withers, and the World is more and more."
TENNYSON.
FOREWORD.
This book embodies the considered opinions of twenty-five years' practical
experience of adult life--as an official reporter and journalist, as a
voluntary war-worker, and as a married woman. For many of the thoughts and
expressions used I am indebted to large numbers of men and women whom I
cannot name, and with whom I have been personally and professionally
associated in different parts of the world. I am also indebted to the
following medical journals for the publication, during the last five
years, of many letters, articles, notes, etc.: _The Lancet_, _The British
Medical Journal_, _Public Health_, _Municipal Engineering_, _Hospital_,
_New York Medical Journal_, etc., etc.
I have to thank the Society for the Prevention of Venereal Disease, the
National Birth-Rate Commission, and the Joint Select Committee (House of
Lords) on Criminal Law Amendment Bills for recording various statements
and evidence.
It remains only to state this fact: That on January 25th, 1922, Sir
Arbuthnot Lane, Sir Frederick Mott, Surgeon-Commander Hamilton Boyden, of
the Royal Navy, and Mr. Harman Freese, of Freese & Moon, manufacturing
chemists, of 59, Bermondsey Street, London, S.E.1, met at my home to
decide upon the best medical formulæ for self-disinfecting ointment for
men and contraceptive-disinfecting-suppositories for women. Mr. Freese
made up sanitary tubes and sanitary suppositories in accordance with these
formulæ, but he is prohibited by law from recommending these for the
prevention of venereal disease, and forbidden to supply printed directions
with them, whereas similar medicaments are being retailed with printed
directions in the State of Pennsylvania, and the Health Department
circularises medical practitioners thus:--
"The self-treatment packet, obtainable at drug stores, to arrest
venereal infection after exposure, is approved by the State
Department of Health on the same principle as is antitoxin given to
diphtheria contacts. Proof is lacking that the use of this packet
lowers social standards. Reduction in the incidence of venereal
disease is a direct result."
But not only in the clear, cool air of American State Departments of
Health is the knowledge and love of sexual cleanliness fructifying. In the
_Dublin Review_ for January-March, 1922, there is a wonderfully fine
article on "The Church and Prostitution," by the Right Rev. Monsignor
Provost W.F. Brown, D.D., V.G., in which he quotes from a very recent
Moral Theology, "De Castitate," by the Rev. A. Vermeersch, S.J., Professor
of Moral Theology at the Gregorian University, Rome, published in May,
1921. The author of "De Castitate" gives brief answers to three questions
put to him, which Mgr. Brown quotes in the original Latin, and of which
the following is a translation furnished by a Catholic priest:--
"You ask
1. Whether or not it is formally sinful to use antiseptic ointment
before illicit intercourse.
2. Whether or not the use of such ointment may be advocated.
3. Whether or not it is lawful for chemists to sell it.
Ad. 1. Although it seems that in England (_cf. Times_, January,
1917) some have made a scrupulous distinction between the use of
this ointment _before_ and _after_, and have forbidden the former
while approving the latter, you need make no such distinction (of
course, supposing the ointment is not used by a woman to
sterilize). It is not wrong to seek means, indifferent in
themselves, which will prevent the evil consequences of sin.
Ad. 2. It would indeed be a sin to reveal such drugs or to persuade
their use with the intention to induce a man to commit sin; but
there is no harm in telling a man who is certainly going to sin how
to avoid the consequences. Ad. 3. If men could be restrained from
vice by prohibiting the sales, this should be done; but so many are
ready to expose themselves to danger that you cannot hope for such
a result from forbidding the sale. It is true this removes _fear_,
but the general good, and the removal of danger to the innocent
justifies this. Besides, it is a poor virtue which is kept from sin
only by the fear of disease."
Having gone so far as to admit the desirability and necessity of the
medical prevention of sexual diseases, the Roman Catholic Church will
certainly find itself later unable to deny the desirability and necessity
of preventing the birth of children liable to be born diseased or unfit.
It is not practicable for a wife to take any suitable precautions against
infection by a diseased husband, which precautions will not at the same
time be effective, to a greater or lesser extent, in the prevention of
conception. There is no half-way house in the matter of sexual hygiene.
ETTIE A. ROUT.
I.--INTRODUCTION.
At present marriage is easily the most dangerous of all our social
institutions. This is partly due to the colossal ignorance of the public
in regard to sex, and partly due to the fact that marriage is mainly
controlled by lawyers and priests instead of by women and doctors. The
legal and religious aspects of marriage are not the primary ones. A
marriage may be legal--and miserable; religious--and diseased. The law
pays no heed to the suitability of the partners, and the Church takes no
regard for their health. Nevertheless, the basis of marriage is obviously
mating, or sexual intercourse. Without that there is no marriage, and with
it come not merely health and happiness but life itself. Cut out sexual
intercourse, and society becomes extinct in one generation. Every
generation must, of necessity, pass through the bodies of its women; there
is no other way of obtaining entry into the world. Hence, it is clearly
the duty of women to understand precisely the processes involved, from
beginning to end.
With the lower animals sexual intercourse is desired only seasonally, and
only for the purpose of reproduction. With the higher animals--man and
women--sexual intercourse is desired more or less continuously throughout
adult life, and desired much more for romantic than for reproductive
considerations--that is, for the sake of health and happiness rather than
for the sake of procreation only. A few women, and still fewer men, have
no sexual desires. To them sexual abstinence seems more natural than
sexual satisfaction. But for the majority of mankind and womankind--for
all normally healthy men and women--there is this continuous desire to be
happily mated.
For the sake of health and happiness there is everything to be said for
early marriage, but better late than never.[A] The chief obstacles to
early and happy marriage are financial, and these would largely disappear
if women were able to control fecundity. The chief obstacles to healthy
marriage are the venereal diseases, and these could be extirpated in two
or three generations if sexual cleanliness was properly taught to all
adults, and if promiscuous intercourse was properly regulated during the
same period. Unfortunately most women's idea of regulating promiscuous
intercourse is to have none of it. This is impossible in the present stage
of moral evolution, but it will become increasingly possible as we
succeed in extirpating the venereal diseases, particularly syphilis.
Syphilis is the one great cause of immorality, because persons born with a
syphilitic taint (and what family is entirely free from this hereditary
disease?) are apt to be mentally and morally deficient; hence, tend to
indulge in anti-social and unnatural practices, such as engaging in
promiscuous intercourse.
[Footnote A: Marriage, whether early or late, cannot of course benefit and
elevate society until the present mischievous and archaic Divorce Laws are
simplified and reformed in accordance with modern sociology and ethics.
Unhappy and unsuitable marriages necessarily foster immorality and promote
disease, and the community as a whole gains by their being dissolved in a
ready but responsible and dignified manner. The refusal of the Church to
marry diseased persons would greatly benefit the nation, whereas its
refusal to marry healthy divorced persons not only injures the nation but
dishonours the Church.--E.A.R.]
The normally healthy man is a highly selective creature, and the normally
healthy woman still more fastidiously selective in romantic relationship.
Neither man nor woman is naturally in the least attracted by promiscuous
intercourse. On the contrary, it is repugnant to both. Both regard the
elements of romance, reciprocity and permanence as essential. These
elements are present in marriage and absent in prostitution. Therefore, it
is beneath the dignity of any decent, intelligent woman to suppose that
promiscuous relationship can ever be as happy and satisfying and
attractive as marriage. This, apart altogether from the fact that marriage
is fertile and prostitution infertile. No, both man and woman desire
love-relationship, not loveless-relationship; and they are really quite
fit to be trusted with the evolution of the race through passionate love
and the worship of beauty, as soon as society makes harmonious provision
for their normal sexual needs. Until society does make early marriage
practicable for all healthy adult men and women, say between twenty and
twenty-five years of age, extra-marital relationship, however undesirable,
is inevitable, because there are many men to whom, at times, any woman is
better than no woman.
But extra-marital relationship is never even safe, because of its
promiscuity and impermanence, except in properly conducted and effectively
supervised tolerated houses. The tolerated house is absolutely necessary
at present to protect women from disease and immorality, by confining this
kind of intercourse as far as possible in certain definite channels. The
abolition of the tolerated house spreads both disease and immorality into
classes of women who would otherwise be immune, and enormously increases
the dangers of promiscuous intercourse. Separated from their toilet
equipment the women cannot make and keep themselves clean; on the streets
they are not taught to refuse intercourse with diseased men; thus their
occupation becomes more and more dangerous as medical supervision is
removed. They inevitably become diseased; sometimes contract mixed
infections, which they pass on to their clients--the future husbands and
fathers of the nation--and "The sins of the fathers are visited upon the
children even unto the third and fourth generation." All this would be
impossible if women generally would recognise the primary fact that
because a man is immoral that it is no reason why he should become
syphilitic. We all want to abolish sin, but failing that we must cease
wanting to poison the sinner. We must actively work to save him from the
penalties of his folly, for that is the only way in which we can save his
victims and succeed ultimately in "Making Marriage Safe."
Similarly every effort should be made to prevent women becoming diseased,
no matter how immoral they may be. The prostitute is very often a woman of
peculiar mentality or overdeveloped animal instincts; and many women are
driven to prostitution by drink and poverty. The prostitute class is
largely recruited from mentally and morally deficient girls, who are
themselves the offspring of syphilitic or alcoholic parents. Prostitution
is the effect--not the cause--of anti-social acts and conditions. We must
remedy the causes of these before we can hope to remove the effects. Under
present social conditions, attempting to abolish prostitution by shutting
up tolerated houses is just as idle as attempting to lower the temperature
of a room by smashing the thermometer. All we can do is to make and keep
these women clean. If we decline to do even that, then diseased women will
succeed in contaminating our men much faster than we can instruct the men
in sexual cleanliness.[B]
[Footnote B: Diseased women will continue to cater for men so long as they
are left free to do so, but as knowledge grows their clients will tend to
be limited to _diseased men_. Once men clearly understand that _every_
casual connection is a risk of disease, they will certainly tend to run
fewer risks.--E.A.R.]
And again, just as the medical prevention of venereal disease was not
proposed, and has not been applied for the purpose of fostering or
condoning promiscuous intercourse,[C] so the conscious control of
fecundity by contraception must not be applied in such a way as to lessen
the proportion of well-born citizens in the nation taken as a whole.
Birth-control applied only by the responsible classes of the community
combined with indiscriminate fecundity among the irresponsible masses,
must inevitably lead to the lowering of the general average in character,
brains and physique. It is a form of reverse selection--the responsible
being out-bred by the irresponsible. What is wanted is the general
application of birth-control by voluntary contraception, and the
particular application of voluntary and compulsory sterilisation of the
feeble-minded and unfit.
[Footnote C: My own experience among the troops quite convinced me that
the more thoroughly and carefully self-disinfection was taught, the less
immorality there was. It was impossible to teach self-disinfection
properly without at the same time instilling a living sense of danger into
the minds of men and women; and this danger-sense certainly led to more
self-restraint.--E.A.R.]
Enthusiastic advocates of birth-control claim it as a means of _improving
the race_. It is not necessarily anything of the kind. You cannot improve
a flock of sheep or a herd of cattle by letting all the individuals breed;
whether each individual has a small number or a large number of offspring
makes comparatively little difference. The way to improve the flock or
herd is to breed only from _the best_ and eliminate the unfit as breeding
material. Changes in environment may improve or deteriorate the
individuals of one generation, but such changes are not inheritable,
excepting in the case of venereal disease. Syphilis, _e.g._, may damage
the germ-cells of a man's body, and thus lead to his procreating diseased
and damaged offspring--idiots, imbeciles, mental or moral deficients, and
so forth, who unfortunately are fertile. Thus the prevention of venereal
disease is a eugenic force. It is in fact the _only_ eugenic force in
operation at present. Generally speaking, it is the well-developed and
high-spirited and enterprising young men who travel most, and who,
therefore, are most likely to contract and spread venereal disease. They
come in contact with a much larger number of women than those who stay at
home instead of wandering abroad. These well-to-do young travellers often
marry the finest of our women, and later in life damage or sterilise them
through latent or chronic venereal disease. Hence many one-child
marriages--due not to the use of contraceptives, but to the action of the
gonococcus transferred to the body of the wife.
But there is this hope. It is among the mentally alert and well-informed
men and women that birth-control is first understood and applied, and it
is among this very same class that the medical prevention of venereal
disease is also first understood and applied. Thus, there will tend to be
less disease among this class than among the mentally torpid and
ill-informed masses of the community. This in itself will not _improve_
the race, but it will prevent the deterioration of certain classes and
increase their numbers. Nevertheless, so long as the irresponsible and
feeble-minded and diseased are permitted to multiply indiscriminately, as
at present, they must ultimately outnumber and overwhelm the classes which
are practising self-restraint or applying birth-control. This process may
even be hastened by a political enfranchisement, which enables twelve
feeble-minded persons to outvote two wise men six times over. Thus, to
succeed democracy must raise and maintain the general average of brains
and character throughout the community. In so far as it permits low-grade
individuals to be born in the homes of the masses, and high-grade
individuals in the homes of the classes, it is manufacturing a rod to
thrash its own back, successful rebellion against which mode of Government
ends in mere anarchy and chaos.[D]
[Footnote D: The present need of the white race is to increase its numbers
of fit and decrease its numbers of unfit. Over-population (except in a few
patches of the Old World) is not likely to be a problem for the white race
for centuries. They have several continents practically empty and
undeveloped, and science has as yet touched only the fringe of the
possible productivity of the earth in the matter of food supplies. The
worst feature of the British Empire is that there are too many Englishmen
and not enough Anzacs.--E.A.R.]
One duty at any rate is quite clear. No woman should run any chance of
conception unless she is certain of her own health and the health of her
partner--the man who is to be the father of the child she is to bring into
the world. If her husband's health is unsound, and she cannot avoid
intercourse, she can certainly take precautions against conception and
against infection. The control of fecundity and the control of infection
are parallel problems, and generally speaking, the measures a woman takes
to prevent conception will also prevent infection. If these precautions
are not taken, a woman may not only become seriously ill herself, but she
may blast the health of her unborn babe--or infect it herself during or
after birth. Clearly then it is her personal, as well as her maternal and
national, duty to apply preventive measures.
Women should understand that there is _always_ a great deal of venereal
disease--millions of fresh cases every year in the British Empire. During
the war there were about half-a-million fresh infections per annum among
the soldiers in the British armies alone--about two million men infected
altogether at the very least.[E] Some were cured, others patched up; some
very badly treated; some not treated at all; many demobilised while in an
infective condition, and thus liable to come home and sow in the bodies of
clean women the seeds of diseases picked up in foreign lands in moments of
excitement and folly. Blame these men if we must, but in all fairness let
us ask ourselves: _Who infected them?_ And the answer is: _Diseased
women._
[Footnote E: The devastation of these diseases among the British armies
abroad (in the Rhine, Black Sea, and Palestine areas, etc.) has been much
worse since the Armistice than during the war. Approximately one-fourth
(sometimes one-half) of these armies become infected with venereal disease
every year. From 1919 to 1921 somewhat soothing statistics were issued for
the army of the Rhine, but these have now been admitted in Parliament to
be "_quite unreliable_" (Parliamentary Debates, House of Commons, November
3rd, 1921, p. 1952). It must be remembered that, owing to the exchange
value of the £, the English soldier on the Rhine is now being paid about
£8 or £10 per day; that is, he draws a far higher salary than the highest
paid German official; hence there is no riotous pleasure, however
expensive and extravagant, which he cannot afford. These conditions do not
promote manly virtue or even sexual cleanliness.--E.A.R]
The venereal diseases are passed on from one sex to the other in a
continuous chain, but the chain can be broken at any time _by either sex_.
And now it is the _married women_ on whom we must rely to see that these
infections are stopped. Leaving women to the chance protection of their
partners is demonstrably a failure. Here is an extract from a letter sent
me recently by an old and experienced medical practitioner:--
"I have had many women under treatment _who have been continually
re-infected by their husbands_."
Men and women must both seek knowledge and both accept responsibility for
the venereal problem. They must face this problem independently and in
co-operation, and above all--face it _honestly_. There is no other way.
It is all very well to say that the man is responsible. That is only a
partial truth.[F] The woman is equally responsible as soon as she is
equally well informed. A woman's body is her own, and she will never be
really free until she knows how to look after it properly. If she is fit
to vote, fit to pay taxes, fit to hold her own estate under the Married
Women's Property Act, why should she not learn to exercise intelligent and
responsible control over her own self? Why do so many women _allow_
themselves to be impregnated and infected against their will? Because they
do not understand the construction and functions of their own body. When
they do understand this, they will guard their own health as carefully as
they guard their reputation. They will then not only keep their own sexual
organs scrupulously clean, but they will encourage their husbands to do
the same. Sexual intercourse is far more refreshing and exhilarating in
every way when both husband and wife have cleansed their parts immediately
before enjoying it. It is only natural that both should wish to be sweet
and clean before approaching the closest of all bodily intimacies.
[Footnote F: It would be much less untrue to say that the remedy for the
venereal problem is _clean women_.--E.A.R.]
But more than this. Every well-informed woman knows that there is far more
venereal disease in the world to-day, among men and among women, than
there was before the war, and she should train all the members of her
household in habits of strict cleanliness. Instinctively they will then
avoid risking their health by contact with a possible source of
defilement, or if the risk has most unfortunately been taken, they will
instantly and instinctively remove and destroy the possible infection, in
the same rapid and effective way as they would cleanse their boot from
filth accidentally coming in contact with it. By all means let the
mothers continue to inculcate virtue, but they should also teach sexual
cleanliness directly and indirectly, themselves setting the example. After
all, the microbes of venereal disease grow almost exclusively in the
genital passages, and if these were kept sweet and clean there would soon
be an end to venereal disease. It is not a matter of making _vice_ safe:
it is a matter of making _marriage_ safe: a matter of restoring and
maintaining physical health, family and national, and above all, of
protecting innocent women and children, for if vice has its dangers so
also in these days has innocence its own peculiar perils, and it is the
cry of these victims--often so young and so fair--that must affect us most
deeply.
More than fourteen years ago, Mr. George Bernard Shaw, in the Preface to
"Getting Married," wrote the following regarding "The Pathology of
Marriage":--
"As to the evils of disease and contagion, our consciences are
sound enough: what is wrong with us is ignorance of the facts. No
doubt this is a very formidable ignorance in a country where the
first cry of the soul is, 'Don't tell me: I don't want to know,'
and where frantic denials and furious suppressions indicate
everywhere the cowardice and want of faith which conceives life as
something too terrible to be faced. In this particular case, 'I
don't want to know' takes a righteous air, and becomes 'I don't
want to know anything about the diseases which are the just
punishment of wretches who should not be mentioned in my presence
or in any book that is intended for family reading.' Wicked and
foolish as the spirit of this attitude is, the practice of it is so
easy and lazy and uppish that it is very common, but its cry is
drowned by a louder and more sincere one. We who do not want to
know, also do not want to go blind, to go mad, to be disfigured, to
be barren, to become pestiferous, or to see such things happening
to our children. We learn, at last, that the majority of the
victims are not the people of whom we so glibly say, 'Serve them
right,' but quite innocent children and innocent parents, smitten
by a contagion which, no matter in what vice it may or may not have
originated, contaminates the innocent and the guilty alike, once it
is launched, exactly as any other contagious disease does; that
indeed it often hits the innocent and misses the guilty, because
the guilty know the danger and take elaborate precautions against
it, whilst the innocent, who have been either carefully kept from
any knowledge of their danger, or erroneously led to believe that
contagion is possible through misconduct only, run into danger
blindfold. Once knock this fact into people's minds, and their
self-righteous indifference and intolerance soon change into lively
concern for themselves and their families."
The facts seem so plain, and yet there is still great opposition to the
promotion of a knowledge of sexual cleanliness and self-disinfection. Only
a short time ago (the end of 1920), Sir Frederick Mott, the great
authority on syphilis, felt obliged to oppose some opponents of
self-disinfection at a public enquiry in London in this fashion:--
"The point is that large numbers of innocent women have suffered
from disease. They are rendered sterile, have miscarriages and
abortions, and large numbers have been ruined. I have been
connected with the London County Asylums for twenty-five years, and
I have seen in those asylums people from all states of society, and
I have seen them die of general paralysis. Five per cent. of the
people who get syphilis, in spite of treatment, develop this
disease. That is only one aspect of it. I was on the Royal
Commission on Venereal Disease, and Sir William Osier, who was a
great authority, said that he could teach medicine on syphilis
alone, because every tissue in the body is affected by it, and that
the diseases of blindness, deafness, insanity and every form of
disease may be due to syphilis. You have only to consider the
effect that it had upon the army, and I understand that more than
two army corps were invalided during the war on account of venereal
disease. What have you to say to that? Does not that create some
anxiety?"
It is difficult even to read this eloquent appeal--the more eloquent
perhaps because it was quite unpremeditated--without being deeply moved.
Yet the witnesses opposing Sir Frederick Mott were apparently unaffected.
Of them, as of men of old, it might justly be said:--
"He hath blinded their eyes, and hardened their heart; that they
should not see with their eyes, nor understand with their heart,
and be converted."
And now large numbers of hospitals all over the Empire are issuing appeals
for the means to treat venereal disease.
"It is tragic," says one London hospital, "to see the
sufferers--men, women and even little children--innocent little
mites, knowing not from what they suffer or why they should. It is
thought by many that venereal disease is a sign of guilt, but large
numbers of our patients are innocent victims."
Is it not time then that we all stopped repeating timid platitudes about
making vice safe, and did something practical to _make marriage safe?_
_Why don't we?_
Is it because we are afraid to define the terms we use so glibly? We talk
of promoting chastity, for example. _What is chastity?_ Surely chastity is
happy, healthy sexual intercourse between a man and a woman who love one
another; and unchastity is sexual intercourse between those who do _not_
love one another. No sexual intercourse at all is neither chastity nor
unchastity; it is the negation of both, and it ends in extinction. Why
trouble so much about a negation that inevitably means racial death? Why
not devote ourselves to life and love; to the building of a happy healthy
human family--a family that instinctively realises that the clean
blood-stream of a nation is its most priceless possession?
But the national blood-stream can never be clean until there is a complete
knowledge of sexual control and sanitation among all of us, and especially
among women. One of the very first things which women must learn to
understand is the control of conception and the control of venereal
diseases. They must learn how to prevent the birth of the unfit; how to
secure the birth of the fit; and even though their husbands are infective
they must learn how to break the chain of infection in their own bodies,
so that what is bad for the race does not become worse. If women are brave
enough and wise enough, they can in most cases _wipe out the scourge of
venereal diseases from their own hearths and homes_, and ensure that every
child born is at least physically fit. But this cannot be done without
_knowledge_, and that knowledge is at present lacking.
The following pages are written with the object of imparting useful,
practical knowledge to sensible and serious women. The women who accept
and apply this knowledge can rest calm in the sure and certain faith that
it is their offspring who will build up the coming race.
II.--PRACTICAL METHODS OF PREVENTION.
A. FOR WOMEN:
SEXUAL REPRODUCTION.
To understand the practical methods of birth-control, or the control of
conception, we must first have a clear view of the processes involved when
the reproductive organs are in activity, and of the nature and situation
of the sexual organs themselves. The diagrams on pages 34, 35 and 36 show
in general outline the reproductive organs of man and woman.
Now fertilisation does not necessarily occur whenever the male organ comes
in contact with the female organ. Fertilisation occurs only when a
male-cell (spermatazoon) unites with a female-cell (ovum); in other words,
when the spermatazoa in the seminal fluid of a man meet and unite with the
germ or ovum in the body of a woman. That is the beginning of the child.
This union of the two cells need not take place during or immediately
after sexual intercourse. It may occur many hours, or even two or three
weeks, after connection, because the spermatazoa have motion of their own.
They are tiny threadlike bodies, which may work their way towards the
ovum long after they have left the body of the man and been placed in the
body of the woman, and the uterus has a searching movement, and may by its
pulsations draw the spermatazoa upwards. For these reasons a woman cannot
be quite sure of the exact time of fertilisation, and hence cannot predict
exactly the date of the child-birth. Generally the pregnancy lasts nine
months, but it may last longer--say ten months on rare occasions; and it
may be extended apparently by a delay in fertilisation.
PREVENTION OF CONCEPTION.
For many reasons which I need not enumerate here, the precautions against
impregnation can most easily and effectively be taken by the _woman_,
rather than by the man. She is the one fertilised, and therefore she is
the one to guard herself against fertilisation.
There are _two methods_ of preventing fertilisation:--
(1) _The chemical method_, that is, the destruction of the male
cells (spermatazoa) by means of a suitable germicidal substance,
such as many of the disinfectants; and
(2) _The mechanical method_, that is, the adoption of measures
which keep the male and the female cells apart from one another.
[Illustration: INNER SIDE OF THIGH.
DIAGRAM 1.--Female organs of generation in normal condition. This shows
diagrammatically the position of the organs if a woman were cut in two
between the thighs. The rubber pessary is shown in position, slightly
distending upper end of vagina (or front passage), and covering the
opening into interior of womb. A suppository introduced beforehand will
dissolve and occupy the dotted space above rubber pessary, forming a pool
around the mouth of the womb. The walls of the vagina are elastic and
collapsible. Infection with gonorrhoea may occur in the female urethra (or
water passage) or in the vagina, etc. Syphilis may infect internal and
external parts of female organs; also breasts, mouth, tongue, etc., and
other openings of the body.]
Neither of these two methods in practical application by ordinary women
can be said to be _completely certain_. Both are apt to fail at times. The
chemical method, that is, the application by the woman of a suitable
soluble contraceptive suppository before connection, or of a germicidal
douche (such as a dilute solution of lysol) after connection, or both
these measures taken consecutively, may fail because of some fault in
application, or because the seminal fluid actually enters the womb during
intercourse; that is to say, when emission takes place, the end of the
male organ may be exactly opposite and close to the mouth of the womb, and
the spermatazoa in the seminal fluid enter directly into the womb, and
cannot then be removed or destroyed by douching or contraceptives of any
kind. Now if the physical conformation of the reproductive organs of the
husband and the wife render this event possible or probable, then soluble
suppositories and contraceptive douching are alike unreliable, by
themselves or in combination. On the other hand, the mechanical method,
that is, the use of a rubber protector, preferably the spiral-spring
occlusive[G] "Dutch" pessary, by the woman may also fail, because the
protector is porous or ill-fitting. But--_if the two methods are
combined_, the chemical method and the mechanical method, _then the
protection against fertilisation may be regarded as almost absolute_. The
completeness of the protection depends, of course, upon the proper
application and combination of the measures advised.
[Footnote G: Judging by certain original letters (dated December, 1888, to
November, 1892), which I have seen myself, by the courtesy of Messrs. E.
Lambert & Son, of 60, Queen's Road, Dalston, London, E.8, the rubber
spring pessary was first suggested here by an English doctor, and
manufactured for him by Mr. E. Lambert Sen. Under date December 23rd,
1888, the doctor wrote:--
"I think highly of the watch-spring rim. There will be very little fear of
conception with one of these new pessaries properly adjusted, as the rim
will press equally all round. The inflated pessary would be the most
perfect, however, if you could only contrive some method to prevent escape
of air and consequent flattening. Such a pessary would be most
comfortable."]
[Illustration: UTERUS, OVARY AND FALLOPIAN TUBE.
DIAGRAM 2.--The Fallopian tubes and ovaries are not shown on Diagram 1.
There are two ovaries and two Fallopian tubes, one on each side of the
uterus. The female cells or ova are formed in the ovaries and discharged
into the Fallopian tubes, along which they travel into the uterus. It is
believed that the union of the male with the female cell usually occurs in
the Fallopian tubes, but that it may occur in the uterus.]
[Illustration: DIAGRAM 3.--This diagram shows the male urethra or passage
down the male organ as somewhat distended. Generally, the walls of this
passage are collapsed together. The seminal fluid is discharged down the
urethra and emitted at orifice marked "meatus." The small glands indicated
are especially liable to be infected with gonorrhoea germs, but infection
may occur almost throughout the entire length of the male passage.
Infection with syphilis may occur on the outside of the male organs and
elsewhere.]
I have discussed the various measures fully with leading medical
authorities in London and Paris and elsewhere during the last five years,
and have gradually evolved the recommendations made here, and these
recommendations have the highest medical and scientific support and
approval. Other methods than those recommended are referred to in Appendix
I; to enumerate here those that have been eliminated would be purposeless
and confusing. We are satisfied that we have selected the least harmful
and most reliable methods known to science yet. These methods and these
only will be explained and recommended. Everything possible has been done
to make the methods _acceptable to women_.
UNATTAINABLE CONDITIONS.
Before detailing these methods, I want to ask every woman to rid her mind
of certain false hopes and impossible demands. It is no use asking for
something which gives no trouble at all, which costs nothing, and which is
at the same time absolutely certain to prevent conception. These
conditions are unattainable. But almost absolute control of her
reproductive functions is most certainly attainable by every careful,
intelligent woman willing to spend a good deal less time and money over
her sexual toilet than she now spends over the care of her teeth, for
example.
SEXUAL TOILET OUTFIT.
To begin with, it is necessary to obtain suitable sexual toilet outfit,
and the requirements for this are as follows:--
Enamel bidet, soluble suppositories, suitable syringe, and
properly-fitting rubber pessary. These are illustrated on pages 38 and 43.
[Illustration: Diagram 4]
GENERAL CONDITIONS.
1. _Cleanliness._--Sexual control is largely a matter of sexual
cleanliness. We must all learn to keep the genital passages cleansed in
the same way as we keep all the other openings of the body clean. The
ears, eyes, nostrils, mouth, anus, orifice to the urethra, and the vagina
should be appropriately cleansed daily. The openings of the body which
stand most in need of daily cleansing are the anus and the vagina, and yet
many women fail to cleanse these properly at all. Every home should have a
suitable bidet (preferably fitted into the bath-room, with hot and cold
water attached), and every member of the family should be trained from
childhood to use the bidet, night and morning, with the same care and
regularity as they use their sponge or toothbrush. All over the Continent
and in the United States of America this is done in well-ordered
households nowadays, but hardly anywhere in the British Empire is it done
at all.
2. _Soluble Suppositories._--Generally speaking, the soluble quinine
pessaries or suppositories which are sold in the shops are unreliable.
Several brands have recently been analysed and found to contain no quinine
at all--or particular pessaries have been without sufficient quinine.
Quinine is fatal to the spermatazoa, and without it these pessaries are
simply pieces of soluble cocoa-butter. Cocoa-butter is the substance
generally chosen for cheap soluble pessaries, because it is easily
obtainable, and has what is called a sharp melting point--that is, it
dissolves or melts very suddenly and readily at body-heat, but is solid
below that heat. Cocoa-butter in itself is quite harmless--usually
non-irritating (unless it is "rancid")--and it gives some mechanical
protection, in the same way as vaseline or any kind of fat or oil would
do, provided, of course, it is in the right place to catch and entangle
the spermatazoa and thus prevent their uniting with the ovum. Research and
experiment have proved conclusively that no spermatazoa--indeed, _no
microbes or germs of any kind--can pass through a film of oil_. But if the
protective covering of grease is incomplete at any point, it may there
prove ineffective, and there is no chemical protection whatever if the
particular germicide relied upon, such as quinine, has been omitted.
Quinine is sometimes omitted on the ground of expense, and sometimes
because it proves irritating to many women. Only really suitable
suppositories, guaranteed to be made in accordance with accredited medical
formulæ, should be used. These suppositories should be composed of
specially selected and tested fats, should be soothing and cleansing, as
well as protective; should be stainless, odourless, and quite
non-irritating. If they do cause any woman discomfort temporarily,
vaseline or soap-suds could be substituted, but might not be quite so
certain to prevent conception.
3. _Syringe._--The ordinary enema is not a particularly suitable appliance
for the purpose of douching. The kind of syringe required is one which
will not only flood the vaginal passage with warm water or very weak
antiseptic lotion (such as dilute solution of lysol), but one which is
sufficiently large for the contents on injection to distend slightly the
walls of the vagina, straighten out their folds and furrows, and thus let
the cleansing and protecting lotion touch every part as far as possible. A
movable rubber flange is necessary to act as a stopper at the mouth of the
vagina, and thus enable the woman to retain the lotion for a minute or so.
Care should be taken, when filling the syringe, to express all the air
from it--by filling and refilling it two or three times with the nozzle
under water; otherwise the first thing put into the vagina would not be
warm water or antiseptic lotion, but simply a large bubble of air.